Methodologically sound, cost-effective research on the outcome of couple therapy

Conceptual and statistical issues in couples observational research: Rationale and methods for design decisions

Observational behavioral coding methods are widely used for the study of relational phenomena. There are numerous guidelines for the development and implementation of these methods that include principles for creating new and adapting existing coding systems as well as principles for creating coding teams. While these principles have been successfully implemented in research on relational phenomena, the ever expanding array of phenomena being investigated with observational methods calls for a similar expansion of these principles. Specifically, guidelines are needed for decisions that arise in current areas of emphasis in couple research including observational investigation of related outcomes (e.g., relationship distress and psychological symptoms), the study of change in behavior over time, and the study of group similarities and differences in the enactment and perception of behavior. This article describes conceptual and statistical considerations involved in these 3 areas of research and presents principle- and empirically based rationale for design decisions related to these issues. A unifying principle underlying these guidelines is the need for careful consideration of fit between theory, research questions, selection of coding systems, and creation of coding teams. Implications of (mis)fit for the advancement of theory are discussed. (PsycINFO Database Record

Long-Term Effectiveness of Treatment-as-Usual Couple Therapy for Military Veterans

Despite the fact that veterans face increased psychological and relationship distress as a result of their service-related experiences, no study to date has explored the long-term effectiveness of couple therapy for veterans. In the present investigation, 238 individuals (113 couples and 12 additional individuals) completed assessments 18 months after termination of treatment-as-usual couple therapy at two Veteran Administration Medical Centers. From pretreatment to 18-month follow-up, couples experienced significant increases in relationship satisfaction (d = 0.59) and significant decreases in both psychological distress (d = -0.31) and presence of intimate partner violence (d = -0.47). Overall, pretreatment demographic, psychological, and relationship characteristics did not significantly moderate maintenance of gains across 18 months. However, African American individuals (d = -0.58) and individuals not reporting intimate partner violence at pretreatment (d = -0.46) experienced smaller improvements in relationship satisfaction through 18-month follow-up. Further, older participants showed smaller reductions in psychological symptoms 18 months after treatment (d = 0.16). Thus, for many veterans and their spouses, treatment-as-usual couple therapy is effective at intervening in psychological and relationship distress long-term. Moreover, the long-term effectiveness of couple therapy with veterans appears to generalize across many demographic, intrapersonal, and interpersonal factors.

Worried About us: Evaluating an Intervention for Relationship-Based Anxiety

Although romantic relationships are commonly a source of pleasure and comfort, for some individuals they can be a source of persistent anxiety. The aim of the current investigation was to explore the construct of relationship-based anxiety and to evaluate the effectiveness of a brief couple-based psychoeducational session for this issue. Common behavioral patterns and cognitive tendencies seen among individuals with relationship-based anxiety were examined, including excessive reassurance-seeking, self-silencing, and partner accommodation. In the current investigation, a single psychoeducational session was developed to address these maladaptive interactive patterns of behavior specifically. The session was administered to a sample of 21 couples and was found to decrease levels of reassurance-seeking and self-silencing significantly among individuals with relationship anxiety, and to decrease levels of maladaptive accommodation behaviors significantly in their partners.

Enhancing the Relationship Adjustment of South Asian Canadian Couples Using a Systemic-Constructivist Approach to Couple Therapy

The effectiveness of systemic-constructivist couple therapy (SCCT) in improving the relationship adjustment of South Asian Canadian couples in ways that attend to their culture was evaluated. The SCCT interventions engage partners in reflexive processing of both their own and their partner's ways of construing, and the reciprocity between these two. A core change mechanism of SCCT, couple identity ("we-ness"), that connotes the ability for thinking and experiencing relationally, was coded from verbatim transcripts of partners' within-session dialogue. As predicted, South Asian partners' relationship adjustment improved significantly from the first to final session of SCCT, and concurrent increases in each partner's couple identity mediated such improvements. The implications for considering culture and couple identity in couple therapy are discussed. Video Abstract is found in the online version of the article.

Couples’ Relationship Self-Regulation Narratives After Intervention

Relationship self-regulation is a way for couples to work on their relationships by becoming reflective about them, by setting goals for improvement, and by following up with efforts to be a better partner. Reflection is an important process in relationship self-regulation addressed in this study. The aim of this study is to analyse relationship self-regulation narratives after a relationship education intervention. Ten married partners (age 33-43 years) participated in a four-day reflective experiential relationship education programme intervention. The study investigated couples’ experiences of working on their relationship after the intervention. Two focus groups were conducted and narrative analysis was used. Four common themes emerged: becoming aware of one’s inner reactions and re-appraisals, learning to be sensitive, noticing one's own habitual responses and making choice, and experimenting in the relationship. These themes are discussed by applying a couple relationship self-regulation conceptual framework. We revealed that relationship self-regulation emerged as a process of regulation of intrapersonal emotional reactions to partner. Reflectivity in relationship self-regulation may be defined as focusing on oneself, trying to understand one’s own feelings and needs, experimenting to meet these needs, and exploring resources. The research focuses on the study of meaning making and on the reflection processes of partners in couple relationship self-regulation.

Assessment of personality organization in couple relationships: factorial structure of the inventory of personality organization and incremental validity over neuroticism

Drawing on a sample of 372 French-Canadian couples, this study examined the factorial structure of a 20-item abbreviated version of the Inventory of Personality Organization (IPO) across a sample of couples and tested if identity diffusion, primitive defenses, and reality testing explain additional variance in couple distress when controlling for neuroticism. The IPO is based on Kernberg's conceptualization of personality organization (Kernberg, 1976 ). Gender differences were also studied through an examination of the value of both self-reported and partner-reported personality in the prediction of each partner's couple satisfaction. Results of confirmatory factor analyses indicated that the tripartite model of the short version of the IPO provided an acceptable fit and proved invariant when tested on couples. Actor-Partner Interdependence Model analyses (Kenny, Kashy, & Cook, 2006 ) showed that elevated neuroticism predicted higher endorsement of primitive defenses, which in turn predict couple dissatisfaction. There was also a direct, negative path from neuroticism to dyadic adjustment. Finally, self-reported neuroticism scores predicted high utilization of primitive defenses by the partner, and low partner-reported couple satisfaction. Furthermore, high self-reported utilization of primitive defenses predicted low couple satisfaction.

Couple therapy for military veterans: overall effectiveness and predictors of response

Despite the numerous challenges facing U.S. veterans and their relationships, there have been no examinations of the effectiveness of couple therapy for relationship distress provided to veterans. In the present study, 177 couples presenting for couple therapy at two Veteran Administration Medical Centers completed assessments of relationship satisfaction prior to therapy and weekly during therapy. Results revealed that the average couple showed significant gains in relationship satisfaction during treatment (d=0.44 for men; d=0.47 for women); gains were larger for couples beginning therapy in the distressed range (d=0.61 for men; d=0.58 for women) than for couples in the nondistressed range (d=0.19 for men; d=0.22 for women). Rates of premature termination were high, with 19% of couples completing fewer than three sessions and 62% rated as not completing a "full course" of therapy. Benchmarking analyses demonstrated that the average gains were larger than would be expected from natural remission and similar to previous effectiveness trials; however, average gains were smaller than those observed in couple therapy efficacy trials. Relationship, psychological, and demographic characteristics were generally unrelated to the amount of change in therapy after controlling for initial satisfaction. However, African American couples showed significantly larger gains than Caucasian, non-Hispanic couples. Thus, though yielding smaller effects than those shown in efficacy trials, the impact of couple therapy for veterans' relationship problems appears to generalize across various demographic, psychological, and relationship characteristics.

Integrative approaches to couple therapy: implications for clinical practice and research

Although meta-analyses affirm that various treatments for couple distress produce statistically and clinically significant outcomes, research findings also indicate that a large percentage of couples fail to benefit or subsequently deteriorate following current therapies. Based on these findings, we advocate potential advantages of integrative approaches to couple therapy. We distinguish among assimilative, transtheoretical, and pluralistic approaches to integration and describe exemplars of each. Integrative approaches to couple therapy are compared to distillatory or common factors approaches emphasizing common elements of treatment components, therapist characteristics, and client or relationship attributes. We argue that clinical practice of integrative approaches to couple therapy requires conceptual and clinical decision-making skills transcending those of any one theoretical modality and emphasizing the selection, sequencing, and pacing of diverse interventions in a coherent manner. We conclude with implications of integrative couple-based treatments for future research.

Research on the treatment of couple distress

This article reviews the research on couple therapy over the last decade. The research shows that couple therapy positively impacts 70% of couples receiving treatment. The effectiveness rates of couple therapy are comparable to the effectiveness rates of individual therapies and vastly superior to control groups not receiving treatment. The relationship between couple distress and individual disorders such as depression and anxiety has become well established over the past decade. Research also indicates that couple therapy clearly has an important role in the treatment of many disorders. Findings over the decade have been especially promising for integrative behavioral couples therapy and emotion-focused therapy, which are two evidence-based treatments for couples. Research has also begun to identify moderators and mediators of change in couple therapy. Finally, a new and exciting line of research has focused on delineating the principles of change in couple therapy that transcends approach.

Couple therapy research and the practice of couple therapy: can we talk?

As has been true in every other realm of psychotherapy, couple therapy research generally has had very little impact on the day-to-day practice of couple therapists. To a significant degree, this unfortunate disconnection may be attributable to an overemphasis by researchers in the field on treatment packages and therapeutic methods/techniques. Insufficient attention has been paid to other important sources of influence on treatment outcomes, especially the couple therapist herself/himself. It is argued that effective couple therapy requires a good "fit" between the person of the therapist and her primary theoretical orientation, and that couple therapists may be more influenced by research that addresses process aspects of the therapeutic approaches to which they have their primary theoretical allegiances.

The effectiveness of couple therapy in Germany: a replication study

The utility of couple therapy has been investigated in a number of controlled clinical efficacy investigations, demonstrating the superiority of most forms of couple therapy relative to control groups. Despite its widespread use, the effectiveness of couple therapy in field settings is largely unknown. In 1997, Hahlweg and Klann published an effectiveness study of couple therapy as practiced in German and Austrian marital counseling agencies. The purpose of the current investigation was to replicate their earlier findings in a similar setting with identical measures. The findings demonstrate that the results are remarkably similar across the two studies and that couple therapy in these applied settings helps to alleviate relationship distress as well as individuals' depression.

From Drafter to Engineer, Doctor to Nurse

This article explored career compromise as negotiated by working-class adults pursuing science-related careers. Using a multiple case study method, we focused on eight individuals who participated in an interview about their career choices and then were followed longitudinally for 2 years. All participants were first-generation college students from working-class families and, at the start of the study, were enrolled at a community college. The results highlight key factors that influenced initial compromises including time and financial constraints, family obligations, and lacking requisite skills. In addition, renegotiations of initial career compromises were sparked by plateaus at work, role models, wanting more money, and having limited time. An extended window of time and financial resources were critical for sustained college pursuit 2 years later. Implications for career development initiatives are discussed.

Demonstrating adherence to guidelines for the treatment of patients with borderline personality disorder

OBJECTIVE

To describe the development and implementation of General Psychiatric Management (GPM), a dynamically informed psychotherapeutic and case management approach along with symptom-targeted pharmacological interventions for the treatment of borderline personality disorder (BPD), derived from the American Psychiatric Association's (APA) guidelines for treating BPD.

METHOD

Clinician adherence to GPM was assessed using the General Psychiatric Management Adherence Scale (GPMAS), which measured the amount of emphasis accorded to therapeutic tools and strategies during individual therapy sessions. GPMAS surveys were completed by 9 different therapists every 6 weeks during 1 year for 50 patients.

RESULTS

GPMAS displayed excellent internal consistency and good-to-excellent test-retest reliability. The convergence between patient- and therapist-rated sessions was excellent. Mean levels of emphasis were significantly greater for GPM interventions than prohibited ones across all time points. The mean number of prescribed psychotropic medications was 2.3, and the most frequently prescribed class of medication was antidepressants, followed by neuroleptics.

CONCLUSIONS

From these results, we conclude that the clinicians were adherent to the outlined protocol and that the GPMAS is a valuable measure for demonstrating adherence to therapies based on the APA guidelines.

Emotionale und kardiovaskuläre Reaktionen von Paaren während einer paartherapeutischen Intervention

Zusammenfassung. Theoretischer Hintergrund: Die Wirksamkeit von Paartherapien und präventiven Interventionsprogrammen für Paare gilt als gut dokumentiert. Das Wissen wie diese Veränderungen zustande kommen ist jedoch defizitär. Aus diesem Grund wurde gefordert, neben dem Therapieoutcome auch die Wirkungsweise der Interventionen zu erforschen. Fragestellung: Ziel der vorliegenden Studie ist es zu untersuchen, wie Paare auf eine bewältigungsorientierte paartherapeutische Intervention, die 3-Phasen-Methode von Bodenmann (2004) , emotional und physiologisch reagieren. Methode: Während eines therapeutisch angeleiteten Gesprächs über ein paarexternes Stressereignis wurden bei den Paaren (N = 18) die Herzrate und das emotionale Befinden erfasst. Ergebnisse: Frauen wiesen gegenüber Männern stärkere emotionale und kardiovaskuläre Reaktionen auf und reagierten empathischer. Die Erfahrung von Unterstützung durch den Partner (dyadisches Coping) war mit einer emotionalen und physiologischen Entlastung assoziiert. Schlussfolgerung: Die Resultate unterstreichen unter anderem die Wichtigkeit des dyadischen Copings für emotionale und physiologische Prozesse während Paarinterventionen.

The clinical representativeness of couple therapy outcome research

The clinical representativeness of outcome studies is defined as the generalizability of recruitment processes, assessment/diagnostic procedures, treatment protocols, and therapeutic results from research settings to naturalistic treatment settings. The main goal of the present study was to examine the clinical representativeness of couple therapy in outcome studies. The data set was formed by 50 published clinical trials, including 34 couple therapy outcome studies for marital distress (CTMD) and 16 couple therapy outcome studies for comorbid relational and mental disorders (CTMD + C). The present findings showed that, overall, the clinical representativeness of couple therapy outcome studies is only fair (i.e., the mean global score is slightly lower than the midpoint of the rating scale used to assess representativeness). CTMD + C studies fared better than CTMD studies on many dimensions of clinical relevance. Studies in which pretherapy training was less intensive (for CTMD studies only), treatment was less structured, and therapists were more experienced showed larger effect sizes than those in which such was not the case.

Treating emotion dysregulation in a couples context: a pilot study of a couples skills group intervention

This article reports the development of a couple-based intervention in which at least one partner had experienced chronic difficulties in emotion regulation, operationalized as having participated in a yearlong dialectical behavior therapy (DBT) skills training group. Integrating dialectical behavior therapy and cognitive-behavioral couple therapy, this group intervention taught couples emotion regulation, communication, and problem-solving skills, and led them through an exploration of how strong feelings affect and are affected by their relationship. The effects of treatment were evaluated in terms of relationship satisfaction and individual well-being. Sizeable treatment effects were found in several domains, including a reduction in DBT graduates' depressive symptoms and emotion dysregulation, and an increase in their partners' relationship satisfaction and confidence in their graduate spouses' ability to regulate emotions.

Relationship violence among couples seeking therapy: common couple violence or battering?

Relationship violence is highly prevalent among couples seeking therapy (Ehrensaft and Vivian, 1996; Jouriles and O'Leary, 1985), yet few couple therapists regularly assess for violence (Dimidjian, Berns, and Jacobson, 1999), and there is limited research on the type of violence most characteristic of couples in this population. The current study uses latent class analysis to examine types of violence in a sample of 273 therapy-seeking couples. The results support a three-class typology, with the groups labeled no violence, low-level violence, and moderate-to-severe violence. Comparisons between the classes support hypothesized differences between groups in degree of marital satisfaction and difficulties in communication, providing further validation of the typology among couples seeking treatment. Clinical and research implications are discussed.

Current Status and Future Directions in Couple Therapy

Couple therapy research affirms that various approaches to couple treatment produce statistically and clinically significant improvement for a substantial proportion of couples in reducing overall relationship distress. Recent studies have extended these findings in indicating the effectiveness of couple-based interventions for a broad range of coexisting emotional, behavioral, or physical health problems in one or both partners. In contrast to these encouraging results, research also indicates that a sizeable percentage of couples fail to achieve significant gains from couple therapy or show significant deterioration afterward. Research on processes of change and predictors of treatment outcome in couple therapy provides preliminary evidence regarding factors potentially contributing to variable treatment response. The chapter concludes with 12 recommendations regarding future directions in couple therapy research and clinical training.

Methodology in family science: introduction to the special issue

Methodology influences every facet of scientific inquiry including the processes of framing questions, operationalizing constructs, sampling individuals within populations and observations within persons, analyzing data, and bringing meaning to the results. This introduction to the special issue on methodology emphasizes the recursive interaction of research methodology and theories underlying family science. Because the science of family psychology is richly complex, so too must the methods for examining couple and family phenomena be equally diverse. Articles comprising this special issue vary in their emphasis on research design versus data-analytic techniques and on confirmatory versus discovery-oriented strategies. The special issue is intended to advance not only the conduct of family science but also the understanding and integration of an increasingly complex research literature by those engaged in education and clinical interventions. ((c) 2005 APA, all rights reserved).